Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design
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2021-12
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<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge.</jats:p> <jats:p>We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>From 2018 to 2020, clinicians at eight VA medical centers received REP-guided implementation including facilitation, technical assistance, and implementation tools to deliver the training program. The project team used the REP framework to develop activities across four distinct phases – (1) pre-conditions, (2) pre-implementation, (3) implementation, and (4) maintenance and evolution – <jats:bold>a</jats:bold>nd systematically tracked implementation facilitators, barriers, and adaptations.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Within the REP framework, results describe how each medical center adapted implementation approaches to fit local needs. We highlight examples of how sites balanced adaptations and intervention fidelity.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The REP framework shows promise for national expansion of the caregiver training intervention, including to non-VA systems of care, because it allows sites to adapt while maintaining intervention fidelity.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03474380">NCT03474380</jats:ext-link>. Date registered: March 22, 2018.</jats:p> </jats:sec>
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Boucher, NA, LL Zullig, M Shepherd-Banigan, KP Decosimo, J Dadolf, A Choate, EP Mahanna, NR Sperber, et al. (2021). Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design. BMC Health Services Research, 21(1). 10.1186/s12913-021-06448-7 Retrieved from https://hdl.handle.net/10161/22915.
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Scholars@Duke
Nathan Adam Boucher
I am a Research Health Scientist at Durham VA Health System’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) and Duke University faculty at Sanford School of Public Policy, the Medical School, and the Nursing School. I am also a Senior Fellow at the Duke Center for the Study of Aging & Human Development as well as Duke-Margolis Center for Health Policy Core Faculty.
I have extensive experience in clinical medicine (licensed physician assistant in critical care and emergency medicine), health care administration, health professions education, hospice and palliative care quality improvement, and community-based research. Challenges and opportunities at the intersection of social care and health care inform my research agenda. My collaborations across disciplines at VA and Duke and with community organizations have afforded me deep insights into the lives and challenges of community members and family/friend care partners.
My research has been funded by Veterans Administration, NIH, Centers for Medicare/Medicaid Services, several foundations, and Duke University. Recent research includes 1) describing care partners’ social and health needs related to caring for older adults re-entering the community from prison; 2) designing and testing community health worker programs focused on older adults; 3) characterizing concerns care partners and people living with dementia have regarding the quality of care settings as well as emerging technologies; 4) systems approaches to homelessness among Veterans, and 5) defining and realigning training and employment for NC direct care workers serving in home- and community-based services.
Let's collaborate: nathan.boucher@duke.edu
Leah L Zullig
Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig leads INTERACT, the Implementation Science Research Collaborative, and is co-leader of Duke Cancer Institute's cancer prevention and control program.
Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 200 peer-reviewed publications.
Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.
Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research
Megan E Shepherd-Banigan
Dr. Megan Shepherd-Banigan designs research studies to improve the health, emotional well-being, and social functioning of adults with mental and physical disabilities. Her methods combine empirical approaches that address methodologically challenging research questions in health systems and policy research. Dr. Shepherd-Banigan uses large survey and administrative datasets to evaluate the impact of policies that support family members to care for adults with disabilities.
Dr. Shepherd-Banigan won a VA Career Development Award from 2019-2024 and is studying ways to strengthen family support for veterans under-going traumatic stress treatment. She also leads a project that surveys family caregivers of Vietnam-era veterans who might be eligible for expanded support services under the VA Mission Act to evaluate program impacts. As co-investigator on an NIA-funded CARE IDEAS study (Terri Wetle, PI) , she is investigating end-of-life-care planning and well-being among dementia care dyads. Finally, Dr. Shepherd-Banigan is leading a project in partnership with the Rosalynn Carter Institute for Caregivers to identify creative empirically-based approaches to support family caregivers.
Nina Sperber
My research career has centered on understanding how to improve delivery of new evidence-based practices in health care systems. I create study designs that integrate qualitative and quantitative methods (mixed-methods) and apply Implementation Science and System Science approaches. I currently have a developing body of academic work that uses participatory system dynamics modeling as a strategy to identify system level factors that affect development and implementation of equitable AI tools. For the VA health care system, I direct a cross-functional team that conducts rapid turnaround projects for high priority needs by VHA national, regional, and facility leaders.
Virginia Wang
Dr. Virginia Wang is Professor in Population Health Sciences and Medicine at the Duke University School of Medicine and Core Faculty in the Duke-Margolis Center for Health Policy. She is also a Core Investigator in the Health Services Research Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Health Care System. Dr. Wang received her PhD in Health Policy and Management, with a focus on organizational behavior. Her research examines organizational influences and policy on the provision of health services, provider strategy and performance, care coordination, and outcomes for patients with complex chronic disease.
Dr. Wang’s research has been supported by the Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases, Department of Veterans Affairs, and the Centers for Medicare & Medicaid Services Office of Minority Health.
Areas of expertise: health services research, organizational behavior, health policy, implementation and program evaluation
Susan Nicole Hastings
Courtney Harold Van Houtven
Dr. Courtney Van Houtven is a Professor in The Department of Population Health Science, Duke University School of Medicine and Duke-Margolis Center for Health Policy. Dr. Van Houtven’s aging and economics research interests encompass long-term care financing, intra-household decision-making, unpaid family and friend care, and home- and community-based services. She examines how family caregiving affects health care utilization, expenditures, health and work outcomes of care recipients and caregivers. She is also interested in understanding how best to support family caregivers to optimize caregiver and care recipient outcomes. She leads a mixed methods R01 study as PI from the National Institute on Aging that will assess the value of "home time" for persons living with dementia and their caregivers (RF1 AG072364). She also directs CASCADE: Center for Advancing the Science of Complex Care: Aging, Disability, and Equity, a grant-funded center within DPHS.
Areas of expertise: Health Economics and Health Services Research
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